Epidemiologic Trends and Practice Patterns in the Management of Sepsis in Emergency Departments: A Five-Year Singapore Cohort Study (2017-2021)

Objective: Southeast Asia is undergoing rapid population ageing, yet longitudinal ED-based sepsis data from the region are absent.We characterised sepsis epidemiology and management trends across three adult emergency departments (EDs) in Singapore over five years, establishing regional benchmarking data and examining evidence-to-practice translation during a period of active guideline change.Methods: We conducted a retrospective cohort study of adult ED encounters with explicit sepsis ICD-10 codes across three EDs (January 2017-December 2021) using the EM-RADAR database.Outcomes included incidence, demographics, admission rates, length of stay, mortality, fluid resuscitation, antibiotic timing, and vasopressor use.Temporal trends were assessed by regression with calendar year as a predictor.Results: Among 1,636,828 ED encounters, 17,117 (1.05%) had explicit sepsis codes.Admissions (98.4%), hospital length of stay (median 6.03 days), in-hospital mortality (8.9%), and vasopressor requirement (4.9%) remained stable.The proportion of patients ≥65 years increased from 68.5% to 72.2% (OR 1.05 per year, 95% CI 1.02-1.07).Balanced crystalloid adoption increased six-fold (11.3% to 61.9%; OR 1.81 per year, 95% CI 1.76-1.86).Median time to antibiotics decreased to 80.8 minutes (IQR 45.5-124.2) by 2021; 64.2% of patients who required vasopressors received antibiotics within one hour.First-line vasopressor use shifted from dopamine (57.8%) to norepinephrine (67.1%).Conclusions: Sepsis incidence (1.05%) was comparable to international reports, predominantly affecting elderly patients.Rapid balanced crystalloid adoption and risk-stratified antibiotic timing reflect successful evidence-to-practice translation.Opportunities remain in reducing antibiotic delays for patients requiring vasopressors and optimizing vasopressor selection.Findings provide benchmarking framework for ED sepsis quality improvement.